Speaker's Highlight

• Don Sin University of British Columbia, St. Paul Hospital (Canada)
  Kenneth R. Chapman Toronto General Hospital Research Institute (Canada)
• Parameswaran Nair McMaster University (Canada)
  Carolyn Calfee UCSF (U.S.A.)
• Gregory P. Downey University of Colorado School of Medicine (U.S.A.)
  David A. Schwartz University of Colorado School of Medicine (U.S.A.)
• Neil Schluger Tuberculosis Control Branch, California Department of Public Health (U.S.A.)
  Nick Kim Critical Care & Sleep Medicine, University of California San Diego (U.S.A.)
• Nicola Hananiah Baylor College of Medicine (U.S.A.)
  Jae-Joon Yim Seoul National University College of Medicine (Republic of Korea)
• Koichiro Asano Tokai University School of Medicine (Japan)
  Diahn-Warng Perng Taipei Veterans General Hospital (Taiwan)
• Konstantinos Kostikas University of Ioannina (Greece)
  Karin Klooster University Medical Center Groningen (Kingdom of the Netherlands)

• Children’s lungs and secondhand smoke in Australia

  Environmental tobacco smoke exposure and lung function decline in children are closely connected. Smoke drifting into homes, cars, childcare centres and restaurants can disturb airway development while a child’s lungs are still growing. The issue therefore belongs naturally in the respiratory programme at APSR 2022, organised in connection with APSR and KATRD.

  Environmental tobacco smoke combines particles, gases, nicotine and combustion products released from the smouldering end of a cigarette with chemicals absorbed from exhaled smoke. Children breathe faster than adults and spend much of their time near adults who smoke. The resulting dose can be substantial without looking or smelling as strong as cigarette smoke itself, and there is no established safe level for children.

  Repeated exposure is associated with more asthma attacks, respiratory infections and wheeze, as well as reduced lung growth. Children who have required hospital treatment for respiratory infection may carry effects into later childhood. Timing matters: pregnancy, infancy and the rapid growth years can be especially influential.

  The burden is uneven. Smoking in multi-unit housing can carry smoke into adjoining rooms, while some regional and remote communities face crowded homes, limited services and sustained tobacco-industry pressure. Clinical care works best when paired with housing, prevention and cessation policy, while avoiding blame or stigma.

  How smoke changes growing lungs

  Smoke triggers airway inflammation, oxidative stress and excessive mucus production. It also makes airways hyperresponsive, so viral infections such as bronchiolitis produce more narrowing and wheezing. In a child with asthma, smoke can worsen control, increase reliever medication use and make attacks more frequent.

  The growing lung may not reach its expected functional capacity when exposure is frequent. Spirometry can show reduced forced expiratory volume, and some exposed children enter adulthood with a persistent deficit. A single reading cannot establish this trajectory, but repeated measurements aligned with symptoms and exposure history can reveal it.

  Vulnerable groups include children with asthma, prematurity or existing lung disease, and those living with a smoker. Exposure is dose-dependent: the number of cigarettes, smoking indoors and the closeness of contact all influence intake. Cutting back at home can help, but eliminating indoor smoking has a clearer effect than moving a chair or opening a window.

  The Australian exposure landscape

  Australian rules vary by state and territory. Broad smoke-free workplace and hospitality laws apply in NSW, Victoria and Queensland, and many jurisdictions restrict smoking in vehicles carrying children. Since national plain packaging began in 2012, high excise taxes have also lifted retail prices. These measures help, although enforcement and affordability remain uneven.

  The nicotine market has changed faster than smoke-free policy. Federal restrictions on imported disposable vapes and limits on nicotine content have altered retail sales, yet e-cigarette advertising, online promotion and products circulating near schools remain concerns. Vaping aerosol can contain ultrafine particles, flavour chemicals and nicotine; using a vape indoors also exposes others to another form of airborne nicotine.

  Living arrangements shape exposure in Australian cities. In apartments and public housing in Sydney, Melbourne or Perth, smoke can enter from common areas, balconies or neighbouring units. In some Aboriginal communities in remote Queensland and Central Australia, a culturally safe response must address housing, tobacco supply, local leadership and accessible treatment together. Bushfire smoke across NSW and Victoria adds another pollutant load, although its composition differs from tobacco smoke.

  Detecting decline and guiding care

  Families may describe a child as “chesty,” “a bit wheezy” or prone to another cold, and clinicians should treat these everyday phrases as prompts for detailed enquiry. Ask where and when symptoms occur, whether they worsen indoors, and whether anyone smokes at home, in the car or during visits. Night cough, exercise limitation and frequent reliever use suggest asthma.

  Spirometry can help, but children need age- and size-appropriate reference equations, commonly expressed as z-scores rather than fixed adult cut-offs. Forced expiratory volume in one second, forced vital capacity and their ratio should be interpreted alongside symptoms and quality of technique. Lung-function decline is established through serial assessment, not one imperfect manoeuvre or a comparison with a sibling.

  Exposure assessment can combine a smoke-free-home plan, medication records, observation of the home or car, and sometimes salivary or urinary cotinine. Biomarkers indicate recent nicotine intake but do not fully capture the pattern or source of exposure. Asthma, viral illness and air pollution can also alter results, so the child’s whole clinical picture should guide decisions.

  Protecting homes, schools and families

  A smoke-free home and car are practical starting points. Ask about cigarettes, cigars, e-cigarettes and cannabis smoke, and work out how visitors, relatives and children’s friends are included without creating shame. Keep windows and doors closed during social gatherings, place smoking outdoors away from entry points, and offer support to the person who smokes rather than simply issuing rules.

  Schools and childcare services can check their policies, staff smoking areas and outdoor gathering zones. Respiratory teams should work with educators and families to reduce the burden of tobacco smoke and vaping without singling out children. Clear school alerts about smoke-free events, transport and excursions can prevent unplanned exposure.

  Cessation treatment should combine coaching, Quitline support and appropriately prescribed nicotine replacement where indicated. Aboriginal health services can provide culturally safe support, and 13 QUIT offers a national route to a counsellor. Before a family leaves the clinic, any written plan should be easy to navigate; teams can assess family-facing resources such as Chilichillin family resources for readability, then add local smoking-cession contacts and emergency instructions.

  Building a smoke-free future

  Policy must close the gaps left by individual advice: smoke-free public housing, stronger retailer compliance, funded cessation services and consistent regulation of vaping. School nurses, GPs, paediatricians and respiratory specialists should share exposure questions and referral pathways. The APSR and KATRD community can connect research on early lung injury with the practical services families can reach.

  Health communication also needs to expose weak claims. Commercial pages often bundle attractive promises with terms that are difficult to notice, as illustrated by a withdrawal payout review. The same discipline—checking evidence, restrictions and actual costs—should guide claims about e-cigarettes or nicotine replacement.

  Prevention works when it is repeated, specific and non-judgemental. A respiratory team can use spirometry, exposure assessment and follow-up to make lung health visible without turning the child into a label. Families can be connected to housing support, smoking cessation and asthma care in one coordinated plan, with school and childcare staff reinforcing the same message.

  If someone in the household smokes, call 13 QUIT (13 78 88) today and arrange a quit plan before the next indoor family gathering.

  Richard Russell Nuffield Department of Clinical Medicine, University of Oxford (United Kingdom)
• Mona Bafadhel King’s College London (United Kingdom)
  David Jackson Guy’s and St Thomas’ Hospital, King’s College London (United Kingdom)
• James Chalmers University of Dundee (United Kingdom)
  David Price University of Aberdeen (United Kingdom)